Surgical suturing instrument



Jan. 17, 192s. 1,656,467 J. A. BLAKE SURGICAL SUTURING INSTRUMENTFi1ed.sept,1. 1926 2 sheets-snee.: 1

attentat "Jan.17,1926., f v C 1,656,467

` J. A. BLAKE SURGICAL suTuRING INSTRUMENT F1166 sept. 1. 1926 2eats-sheet aucunes,

Patented Jan. 17,1928.

UNITED STATES PATENT OFFICE.

SURGICAL SUTURING INSTRUMENT.

Application ined september 1, 192e. serial No. 133;(154.

`This invention relates to surgical instruments, particularly tosuturing devices, and has tor `its object the provision of a novelinstrument by"means oi' which stitches or s sutures ot anysuit-ablelexible material may be made in or applied to a wound orincision.

y An important object of the invention is to provide an instrument ofthis character so constructed and arranged that it may lo be used forapplying a. series `of stitches or sutures at equally .spaced points, orindividually placed stitches which may he the same or variable distancesapart as preferred.

Another object is to provide aninstrument ot .this character embodyingneedles and handle means so connected therewith as to he capable oitoperation in a step-like manner so that during the operation of takonestitch one needle will overlap the other while at the nextsucces-:iveoperation it will underlie the same, the alternate or steirlilre actionproducing a series ot uniform stitchesat the same distance apart.

A further-object of `the invention the provision of an instrument ofthis character in which the construction and `arrangement oij' iliarlsare such that `only the initial stitch wiil extend across the outside`of the incision or wound in visiblei'position, all the subsequentstitcheegheing concealed except at the ends where the looping, automaticor manual., ot the successive stitches is effected, the interloopingbeing;v automatic or manual dependent upon the selected manner in whichthe instrument is used.

A still further object ot the invention is lo provide a suturing deviceprovided with adju-stable tension means for whatever' flexible materialis used such as wire,gut or silk.

Another object is to provide an instrument ot this type havingdetachable needles ot different varieties capable of selec-tiveenuiiloyment depending upon the nature oi the stitch desired.`

An additional objert is to provide a sutur-l and claimed, andillustratedin the accompanying drawings in which zv Figure l'is a tront elevationot' the instrument showing it in normal position and equipped with theneedles for citer-ting the staggered'or oltcenter stitching. A

Figure 2 is an edge elevation.

vFigure 3 is a plan viewror elevationlooking` at the needles. y

Figure 4 isa detail sectionalview through the pivot -joint showing theintermediate position of the parts tor oicenter stitching.

Figure 5 is a similar View showing the pivot elementin position withinthe throat orslot preparatory to arranging `the parts for on-centerstitching.

Figure 6 is a View similar to Figure 5 with the pivot in the lateralslot ready for oli-center stitching. Y

Figure 7 is a detailsection `through a portion ot one handle member`showing the vdetachable mounting of the needle therein.

`Figure 8 is a section taken at right angles to Figure 7.

Figure 9 is a fragmentary side elevation showing thetension device.

Figure l() is a perspective `view of the tension plate removed.

FigureA 11 is a. cross section taken on the line 11.--11 of Figure 4. yy

F'gure 12 is a side elevation of a. portion ot' theV instrument showingthe position ot the needles for starting a suture.

Figures `13, 14, 15 and 16 are similar views showing successive steps inoff-center stitchmir.. i

`Figure 17 is a view showing an .incision as stitched bythe instrument,the stitches being of course greatly exaggerated tor the sake ofclearness.

Figures 18, 19 and 20 are 'fragmentary `views showingthe type ot'needles employed ilor on-center stitching, thethree views illustratingsuccessive steps.

Figure 21 is an elevation of a wound. or incision `stitched h v theonrenter method.

Figure 22 is a longitudinal section through one of the needles foreil'ecting the ott-center stitching. and

Figure 23 is al det-ail section through the and portion thereof.

Referring more particularly to the drawing.. I lmveehown the devicer ascomprising a pair ot blades or handle members 1 and 2 which are somewhatsimilar in construction litt and o't the same general contour exceptthat the former shown as provided with a loop 3 constituting a thumbhold Whereas the latter is provided with tivo loops el and for theoretiuger and remaining lingers .respectively. ylhe members 1 and 2 areboth termed with similar' extensions (i which diverge and each ot whichis formed with va socket T into which leads a hole S for apurpose to bedescribed.

rl`he members 1 and 2 are pivotally connected by a peculiar' joint whichpermits the members to pivot or simple relative rotary movement inopposite directions pr for relative rotary or rocking movement ondillierent axes, depending upon the nature of the stitch or suturedesired, this depending, in its turn, upon the character of the wound orincision. In the present instance, the pivot means is shown ascomprising afpivot meniber 9 having a squared or other angu lar portion10 statlonarily mounted through the member 2. Obviously this member maybe welded, brazed or otherwise permanently tastened or litmaybe providedat one end with a head 11 for the purpose et preventing longitudinadisplacement in one direction. llVhere the member 9 passes through themember 1, it is formed with a cylindrical portion 12 which .entends fora distance preferably substantially one-halt Vthe thicknes of the member1, the remaining portionbeing out away at opposite sides as at 13 todefine a constricted neck lll terminating in a head 15 located againstthe outer side ot the member 1 for preventing longitudinal displacementof the member 9 in the other direction. Clearly, this pivot member S) isneces'arily formed ot at least tivo parts which are rigidly securedtogether zitter assen'ibling with respect to the blade or handle members1 and 2. The member 1 is shown as formed with a longitudinally extendingslot 10 of at least the same `width as the diameter of the cylindricalportion 12 et the pivot member, and located at one side of t-he slot- 16is a lateral opening 1T oi' sul stantially the same Width as thecylindrical portion 12. A portion otthis opening leads directly into theslot 16 wherein'T the remaining portion registers with a circular hole1S which communicates with the slot 16 through aconstricted throat 19.Clearly, when the handle members are in their normal positiernas shownin Figures 1 and i the cylindrical portion 12 of the pivot member islocated Within the longitudinal slot 16 so that the handle members 1 and2 mayv be moved relatively in a longitudinal direction simultaneouslywith or prior to pivoting. Bv swinging the handle members 1 and 2 withrespect to each. other they may be brought into the position shown inFigure 5 so that the constricted neck portion 14 of' the pivot may bepassed through the throat the grips have been squeezed together duringthe taking ot a stitch as will Abe described, l preterably provide aleaf spring 2O located between the members l and2 Vand secured at one-end to one, the other end having a slot 21 therein detachablyfengagedupon a pin projecting *from the .other handle member. When it .isfdesired to change the pivot 9 from engagement Within the slot 1o toengagement Withinthe ihole 18, or `vice 'versa7 it is of course necesarythat the slotted end ot theispringfbe disengaged trom the pin 22 sothatthe handle members may be moved relatively zto the necessary extent iorpermitting manipulation to shift the pivot.

t is possible to u'eneedles of twoftypes, as will be explained, one typefbeing designated by the numeral 23 and the other `by the numeral 24.Only the former are shown in detail for the reason that both varietiespossess the same general characteristics in point olf.1nounting,ietc.The Vneedles 23 Vare represented as ofidenticulconstruction and each'isformed into a curved orhoolr-shaped bodyv 25 flat on their inner,abutting 'faces and rounded on theirouter faces and termi nating in asharp point 26 adapted to be penetratingly engaged through the edgesl Aot a u'ound or .incision B. Each needle is formed with a longitudinalpassage 27 which opens out at one end to the side through a hole 28located some distance back .of the point. The other end ot' the passageleads out to the outer edge of the needle through c liaringopening 29 inoverlapping relation to which is arranged a tension device for the wide,gut. silk or other material to be used for suturing It is intended thatsuch flexible material` indicated at 30. he used in the 'term et asingle strand which may initially he cut to the proper length for sewingor stitching the particular Wound or incision in question. This fiexiblemember is passed through the passages 27 iubothneedles and extendsacross the points thereof. the ends being left free as indicated inAFigures 1 and2. v

For preventing accidental shifting of the flexible material` I provideny tensioning device 31 which in the present instance is shown asconsisting of an angular plate 32 having a tapered opening 33 thereinadapted to he. brought more or less into registration `or lesscompressing or frictional engagement with the .flexible material. `Eachneedle is shown as having such a tensioning device.

`Clearly, some other structure of an equivalent nature may be providedfor this purpose there 1leeing no particular limitation in this respect.

The means for soeiation with the blade or handle members 1 and 2 is hereshown as comprising reduced extensions 37 formed integrally upon theneedles and slidablyiengaged Within the sockete` 7, each extensionbeingcut away at `one side as shown at 38 to accommodate or permitinward movement of a leaf spring 39 ivlii ch is anchored to theextension at one end as shown at l0 and Which has its other endcari-yimg a pin Ll1 engage-able Within the hole S. This connection Willhold the needles lirmlywvith respect tothe blade or handle members Whileat the same time in case it is desired to remove the needles it iseasily accomplished provided some pointed imple-` ment be insertedthrough the holes 8 to ell'ect disengagement of the pins 41 therefrom.Clearly, an equivalent mounting may be provided Within the spirit of theinvention The needle members 24 may be constructed infidentically thesame manner as the needles Q3 except that they are ot` such curved shapethat the points thereof are arranged in end t'o end relation instead ofbeing overlapped as is the case with the needles `23.

lin the operation, 4let vit be first assumed that. it is desired to sewup the Wound or incision B with a series of automatically interlinlredstitches, orby means of the olfcenter method. lnsuch an event, the pivotmember 9 isarrangedto be located entirely within Vthe slot 16, `as shownin Figure 4.

W ith, say, the handle member 1 moved longi# `tinlinally with respect tothe handle member 2 to bring the pivot at thelower end of the slot 1G,the point of the needle carriedfby the member 2 is torced through theedges of the incision as shown in Figure 12, the flexible material 30beingdraivn through the edges and forming a loop 42, that portion 43 ofthe flexible material which initially bridged the needles being broughtacross the incision as shown. The operator ol' course holds the deviceinoiie hand with his thumb extending 4through theloop 3, his forel'ingerthrough the loop -land his remaining fingers through the loop 5 so thatthe device may be manipulated inl a manner similar to scissors orholding the needles in as-` pliersf Then the handle members are thensqueezed together, it is intended that prior thereto, or simultaneouslytherewith, (the `handle member 1 be moved downwardly so that the pivot?)will approach the other end oli. the slot 16, the intermediate positionbeingsliown in Figure 13 and the final position in Figure 14. As thehandle members are brought together and moved relatively in alongitudinal direction, the point ofthe other needle, the one carried bythe handle l, is engaged through the loop 42, dragging it down to theposition shownfin Figure 15,`

and at the end ol' the relative longitudinal movement of the membersland 2 thisneedle is forced through the edges of the incision,

as shown iii Figure 15, the needlecarifing the thread therein throughthe skin or esh. This results in anchoring the stretch 43 0f theflexible material Which initially bridged theneedles. This also forms aloop 44 at the opposite side ot' the incision from that where the loop452 is located. The handle members rand i2 are then slid longitudinallyrelatively in ine opposite direction to bring the needle carried by thehandle 2 to a point below the other needle, the point of the needleengaging within the loop 44: anddragging it down, as shown in Figurel.This needle is then loi-ced through the incision to the opposite side,to form the next loop in which the needle farried by the handle 1 isengaged in inentis continued until the Wound or incision is 'hillystitched or sewed as shown in Figra similar manner. This step bystepniiove- Y lee handle members 1 and 2 manipulated to bring the pivotmember 9 into the circular holle 18 so that the needles will be held inend to end relation While the handles 'are swung upon a single axisinstead of being moved longitudinally as Well, as above described. Institching with these needles, they are first arranged in spaced relationat opposite sides of the incision. shown in .Fign ure 18,y `the portionLl5 et' the 'flexible nia` terial bridging the needles, extending acrossthe outside ot the incision.` The operator then squeezes the handlestogether to force ige are `Withdrawn and the instrumentmoved to a 'newposition along the incision. Upon reaching this lnew position, Vtheneedlesare engaged through the loops 46 and forced through the edges ofthe incision. This operation is repeated until the desired number ofstitches have beentaken.

. suchias is sometimes neces From the lforegoing description and a studyof the drawings, it will be apparent that I have thus provided a simplyconstructed instrument which Will be very convenient to use not only onaccount of the rapidity .of the action but also on :account 'of lthene-atness and uniformity of thestitching. It .is really believed `thatthe construction, operationand :advantages Will be readil apparent toone skilled inthe art Without yiirther explanation.

The improved suturing device is admirably adapted Ifor either internalsuturing, iry in abdominal operations or the like, or in externalsuturing of wounds, or incisions. As has been stated either of theseoperations may be performed with the `device arranged tor what has beentermed off-*center suturing, that is, with the pivot arranged in theslot and the needles alternating in their movements. lVhen the Wound or'incision has been seived or sutured in the manner describedand withonly the single, initial strand ofthe sut-ure exposed, the edges A areforced inwardly by the bandages which are applied afterwards so thatthey lie in edge to edge relation, and the stitches are consequentlystretched taut with the result that such relation ismaintainedthroughont the healing period and a muchcleaner, smoother,single-line scar is the result, Without the usual unsightly roughnesscaused by the ordinary over and over stitching. The long loops at thesides of the scar may also'be readily severed when the proper .periodarrives for the stitches to be removed. The form of. stitching relierredto as oncenter stitching, where the pivot remains stationary and theconcentric needle-s are employed, is used solely for external sewing,because of the use of the loop-holding de vice in the lorm ot thetwo-pronged fork, at a certain stage in the operation ot suturing inthis manner.

It Will be 'further seen that the operating surgeon in manipulating thissingle handed instrument, either in the ori-center or the o'ticentermethod ot' using the same, has the use of his other hand to hold theedges of the wound or incision together or to apply and detach theloop-holding it'ork, thus eliminating the necessity ot an assistantsurgeon to perform such functions.

'lVhile I have shown and described a preferred embodiment of theinvention, it should be understood that I reserve the right to make suchchanges in the form, construction and arrangement of parts as will notdepart Lemme? from the spirit of the invention or the scope ofthesubjoined claims.

What is claimed is:

l. In an instrument of the character described, a pair o `handle memberspivoted in crossed relation land terminating in linger grips, andneedles carried by the handle members adapted to operate in overlappingrelation, each needle having a longitudinal passage therethrough openingout at onelside in spaced relation to the end and opening outat itsother end adjacent the handle member. Y

2. In an instrument of the character described, a pair of handle memberspivoted in crossed relation and terminating inlinger grips, .and needles`carried `by the .hand'le members adapted to operate .in .overlappingrelation, each needle having a longitudinal passage therethroughopeningout atone'side in spaced relation to the end -andgopening out at itsother end adjacent the handle `member,-said `passage beingadapted forthepassage ot flexible suturing material, and means located at the secondnamed opening orapplying tension to the suturing material.

In an instrument ofthe character describel, a pair of handle memberspivoted in crossed relation and terminating in linger grips, and needlescarried by the handle members adapted to operate in overlap ingrelation, each needle havinga longitudinal passage therethrough openingout at one side in spaced relation Vto the end and opening out at itsother end adjacent thefhandle member, the passage being for the feedofsuturing material, and an adjustable plate member mounted adjacent `eachsecondnamed opening and apertured for the lpassage of the suturingmaterial, the plate member being adjustable to regulate the position ot'the aperture therein with respect to the second-named opening.

A. In an instrument ot' the character described, a pair of handlemembers pivoted in' crossed relation and terminating in linger grips,and needles carried by vthe handle membersadapted to operate inoverlapping relation, each needle havinga longitudinal passagetherethroughopening out at one side in spaced relation to the end andopening out at its other end adjacent the handle member, the vpassagebeing lor the accommodation olil suturing material, and tension meansfor the material comprising an angular plate member carriedrby eachneedle at the second named opening and having an aperture adapted toregister to a greater or less extent with the second named opening, andmeans for adjusting thc position of the angular plate.V Y Y 5. VIn aninstrun'ient ot' the character described` a pair ot handle memberspivoted in crossed relation and terminating at one end in grips, theother ends of the handle i :in

members diverging and being formed with sockets, needle members carriedby the handle members and having reduced extensions engaged Withinsaidsockets, and latch means for retaining the extensions Within thesockets. i l

6; In an instrument of the character described, a pair ot handle memberspivoted in crossed relation and terminating at one end in grips, theotherends of the handle members diverging and being formed with sockets,needle members carried by the handlemembers and having reducedextensions engaged Within said sockets, each extension being cut away atone side, a leaspring secured atl each cut away portion and carrying apin, the handle member having a hole comi'nunicating with the socketlfor the reception of said pin.

7. In an instrument of the character de scribed, a pair of handlemembers arranged in crossed relation,`necdles carried by the handlemembers, and means pivotally and slidably connecting the handle memberswhereby the needles ma be caused to move in different` arcuate paths.

8. In an instrument oi.' the character described, a pair of handlemembers carrying needles, means pivotally connecting said members andselectively coniining them to movement about a common axis andpermitting relative sliding movement irrespective` of the pivoting.

9. In yan instrument of the character de-v scribed, a pair of handlemembers carrying needles, means pivotally connecting the members, andmeans permitting shifting of the pivot point.

10. In an instrument of the character described, a pair of handlemembers carrying the pivot point, and means for preventing theaccidental shifting of the pivot point.

12. In an instrument of the character described, a pair of pivotedhandle members arranged in crossed relation and carrying needles, oneo't' said members having a longitudinal slot receiving the pivot forpermitting longitudinal movement of the mem bers relative to each other.

13. In an instrument of the character described, a pair of handlemembers arranged in 4crossed relation, needles carried by the handlemembers, a pivot member carried by one handle member, the other handlemember having a longitudinal slot and a transverse opening communicatingtherewith, the pivot member being `selectively engageable within saidslot or said opening.

11i. In an instrument of the character described, a pair of handlemembers arranged in crossed relation, needles carried by the handlemembers, a pivot member carried by one handle member, the other handlemember having a longitudinal slot and a transverse opening communicatingtherewith, the pivot member heilig selectively engageable Within saidslot or said opening, and means for retaining the pivot member in theopening.

l5. In an instrument of the character described, a pair of handlemembers arranged in crossed relation, needles carried by the handlemembers, a pivot carried by one handle member at the point of crossing,the pivot having a cylindrical extending portion and a constricted neckportion, the other handle member having a longitudinal slot slidablyengaged upon said cylindrical extending portion and having a lateralopening communicating with the slot through a constricted throat, thehandle members being relatively movable to pass said constricted neckportion through the throat into said lateral opening.

In testimony, that I claim the foregoing as my own, I have hereto aiixedmy signature. i

JOHN. AMMEN BLAKE.

